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V I E W P O I N T

Fruit Drinks:
How Healthy and Safe?
Fruit drinks are popularly used in most urban
households. Historically, the use of fruit juices
began with consumption of orange juice, as a source
of vitamin C to prevent scurvy. However, today
markets are flooded with a large variety of juices
e.g., mango, apple, guava, litchi, grape, pineapple,
etc. The main reason for increased consumption is
changing lifestyles and rising level of health
consciousness among consumers and parents.
They believe that these drinks provide superior
nutrition because of their fortified status and high
beverage cost. Child preference, easy availability,
convenience, naturalness and marketing strategies
have given fruit drink industry a booming growth.
Recent pesticide issue of soft drinks has further
augmented sales of fruit drinks.
DEFINITIONS: FRUIT JUICE, FRUIT DRINK
AND NECTAR
American Academy of Pediatrics (AAP) defines
fruit juice as either natural or 100% concentrate
without added sweeteners. Anything less than 100%
concentrate is labeled as drink, beverage, or
cocktail(1). Fruit drinks are defined as calorically
sweetened beverages with a small percentage of fruit
juice or juice flavoring containing carbonated
water(2). Fruit drinks have less than 20%
concentrate and nectars have around 20 to 99%
concentrate. Sometimes, fortifiers such as vitamin C
or calcium are also added to the fruit drinks.
Fruits and 100% juices contain water, simple
carbohydrates (sucrose, fructose, glucose, sorbitol),
high amount of vitamins (C, A) and minerals
(potassium, calcium etc.)(1). However fruit drinks,
even 100% juice is not equivalent to whole fruits.
Fruits supply fibers and phytochemicals to diet,
which are not present in juices. Fruit juice devoids
the child of opportunities to learn skills like peeling,
chewing, and differentiating between colors,
textures and shapes. Fruit drinks, thought to be
INDIAN PEDIATRICS

complete source of energy, vitamins and minerals


are actually a mere sweet drinks and poor source of
nutrition. Whole fruits are less calorigenic as
compared to fruit juices and fruit drinks.
THE BUSINESS BOOM IN FRUIT DRINK MARKET
The mean juice consumption in US is as high as
2 billion gal/y, with an average 9.2 gal/y/person
with children consuming the maximum (28%)(3,4).
The fruit juice consumption in pre-school children
increased from 3.2 to 5.5 fl/oz/day(5). By one year of
age, 90% children in US are consuming fruit
juices(1). Even in India, in-home juice consumption
has increased from 30 to 80% in last 3 years(6). The
Indian fruit drink market is estimated to be 1200
crores(7). The commonly available brands in Indian
market are from Dabur (Coolers and Real), Pepsi
(Tropicana, Tropics, Slice), Coca Cola (Maaza),
Mother Diary (Safal) and Godrej (Xs range). These
are marketed in different flavors: orange, mango,
pineapple, lichi, apple, grape etc and include fruit
juices, fruit drinks and nectars. The fruit drink
market is growing further at the rate of 20-25%.
The major share (60%) is contributed by fruit
drinks while fruit juices account for only 30% and
nectars for the remaining 10% market(6). The
growing popularity and unrestricted consumption
of fruit drinks especially in children is a serious
concern.
RECOMMENDED DAILY ALLOWANCE (RDA)
Fruits are one of the 5 major food groups in food
pyramid. American Academy of Pediatrics (AAP)
recommends that those who require 1600
Kilocalories (1-4 years of age) require 2 fruit
servings and those who require 2800 Kilocalories
(10-18 years of age) require 4 fruit servings(1). In
them 50% can be provided as fruit juice (not fruit
drink) with each serving of 6 oz. No juices are
recommended for infants less than 6 months of age.
The committee advocates and encourages use of
fruits as compared to juices to meet the daily
requirements and energy balance. However, fruit
intake in diet is found to be low. In American
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GUPTA, et al.
Key Messages: Tips For Parental Education on Fruit Juice
Encourage children to eat whole fruits.
Juices should not constitute more than 50% of the daily recommended intake of fruits.
Do not feed fruit juices to infants below 6 months.
Fruit juices or drinks should not replace milk in the diet.
Consume only 100% fruit juice and that too in appropriate amount.
Fruit juices can be a healthy sources of minerals and vitamins if given judiciously but may have adverse effects
if consumed excessively.

juices have high quantity of sorbitol which is


nonabsorbable and high fructose-glucose ratios. A
health care professional should be consulted before
recommending fruit juice in diarrhea, dental caries,
and malnutrition. Few studies have shown that
intake of fruit juices in huge quantity is associated
with short stature, obesity, diabetes mellitus and
malnutrition(8). However, Skinner, et al.(12)
recently showed that in a sample of young children
there was no association between short stature and
obesity and high fruit juice intake.

children, only 80% of the RDA is met for fruits and


that too 54% from fruit juices. The pattern of juice
consumption in one study was as follows: mixed
(39%), apple (30%), orange (23%), grape (7%), and
pear (1%)(8). Corresponding data are not available
for Indian children.
POTENTIAL HAZARDS OF FRUIT DRINKS
Children have preference for fruit drinks as they taste
good, packaging has an eye appeal, are inexpensive
and convenient and hence are replacing important
food items in diet. Mothers use them very commonly
in diet. A survey of infant feeding in Asian families
in England showed that at 5 months of age, 75% of
Pakistani and White mothers, 63% of Indian mothers
and 61% of Bangladeshi mothers were giving fruit
juices as source of non milk drink(9).

APPROPRIATE CONSUMPTION OF FRUIT DRINKS


Fruit drinks, if consumed in appropriate quantity,
can be a part of balanced diet for children, and are
not always harmful. Studies have shown that vitamin
C and flavinoids in juices have beneficial long term
health effects like decreasing the risk of cancer and
heart disease(13). Vitamin C by increasing iron
absorption to almost double can reduce the incidence
of anemia in population consuming diet with low
iron content and bioavailability(14). However, the
awareness and education of these details is lacking
among general population.

By displacing milk in diet the number of children


meeting RDA for calcium has drastically reduced to
just 50% and thus a great health concern. The
calcium in these juices is not biologically equivalent
to milk calcium. The iron in the marketed juices
is also absorbed variably. High vitamin C in
them promotes iron absorption but polyphenolic
compounds in certain juices inhibit iron absorption.
Fruit drinks are thought to be good source of
minerals and hence inappropriately used in diarrhea
when it is known that they are not balanced fluids in
this condition and even aggravate diarrhea or rather
cause toddlers diarrhea(5). Fruit drinks are common
cause of tooth decay and promote picky feeding(10).
Unpasteurized juices can be a source of serious
bacterial infections. Change in bowel habits i.e.,
abdominal distension, flatulence and diarrhea are
frequently observed with fruit drinks(11). This is
because of carbohydrate malabsorption as these
INDIAN PEDIATRICS

ROLE OF IAP AND CONSUMERS


With markets overflowing with wide variety of fruit
drinks and consumers half aware of the benefits and
adverse effects, it is a serious issue to be addressed.
Also, no clear system or guidelines regarding
nutritive and energy density, health preferences and
risk related with fruit drinks exists in India. Unlike
AAP, the Indian Academy of Pediatrics (IAP) has
not formulated any guidelines regarding fruit juice
consumption in children. It needs to set up a Task
force to look into these issues and formulate new, or
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VIEWPOINT: FRUIT DRINKS


Opinion Research. Cited by: Clydesdale FM,
Kosala KM, Ikeda JP. All you want to know about
fruit juice. Nutrition Today 1994; 2: 14-28.

adopt, or adapt the existing AAP guidelines. Drinks


do not label the exact concentration and this may
misguide consumers. There are no guidelines printed
on labels regarding the safe intake for different age
groups. Pasteurization details are not clearly
mentioned. Thus guidelines for manufacturers need
to be made. Parents should be made aware of these
minute details and to read the label to identify the
exact nature of the constituents of the fruit drink to
know what they are offering to their child.
Contributors: PG conceived the article. HG collected
literature, and drafted the manuscript. PG helped in
drafting and critically analyzed the literature and edited the
manuscript. Both authors approved the final manuscript.
Funding: None.

5.

Dennison BA. Fruit juice consumption by infants


and children: a review. J Am Coll Nut.1996; 15: 4S11S.

6.

Sharma A. More juice in the fruit market. From:


http://www.rediff.com/money/2004/jul/31spec3.
htm. Accessed February 10, 2008.

7.

Jagannathan V. Minute Maid crosses 2 million sales


mark. From http://www.domain-b.com/companies/
companies_c/coca-colaindia/20070510_million.
htm. Accessed February 10, 2008.

8.

Dennison BA, Rockwell HL, Baker SL. Excess fruit


juice consumption by preschool - aged children is
associated with short stature and obesity. Pediatrics
1997; 99: 15-22.

9.

Watt RG. A national survey of infant feeding in


Asian families: summary of findings relevant to oral
health. Br Dental J 2000; 188: 16-20.

10.

Davis JR, Stegeman CA. The Dental Hygienist


Guide to Nutritional Care. Philadelphia: WB
Saunders; 1998.

Competing interests: None stated.

Hema Gupta and Piyush Gupta,


Department of Pediatrics,
University College of Medical Sciences and
GTB Hospital, Delhi 110 095, India.
Email: hema_g10@hotmail.com
REFERENCES
1.

American Academy of Pediatrics. The use and


misuses of fruit juices in Pediatrics. Pediatrics 2001;
107: 1210-1213.

11.

American Academy of Pediatrics, Committee on


Nutrition: The use of fruit juices in diet of young
children. Am Acad Pediatr News 1991; 7: 2.

2.

Pompkin BM, Armstrong LE, Bray GM, Caballero


B, Frei B, Willett WC. A new proposed guidance
system for beverage consumption in the United
States. Am J Clin Nut 2006; 83: 529-542.

12.

Skinner JD, Carruth BR, Moran J, Houck K,


Colletta F. Fruit juice intake is not related
to childrens growth. Pediatrics 1999; 103:
58-64.

3.

Agriculture Research Service. Food and Nutrient


Intakes by Individuals in United States by Sex and
Age, 1994-1996.Washington, DC: US Department
of Agriculture; 1998. NFS Report No. 96-2.

13.

Ames BN. Micronutrients prevent cancer and delay


aging. Toxicol Lett 1998; 102-103: 5-18.

14.

Hollman PC, Hertlog MG, Kalan MB. Role of


dietary flavinoids in protection against cancer and
coronary heart disease. Biochem Soc Trans 1996;
24: 785-789.

4.

National Family Opinion Research. Share of Intake


Panel (database) Greenwich, CT: National Family

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